Respiratory Therapist-Driven Mechanical Ventilation Protocol Is Associated With Increased Lung Protective Ventilation.

Background: Mechanical ventilation is a common life-saving procedure but can lead to serious complications, including ARDS and oxygen toxicity. Nonadherence to lung-protective ventilation guidelines is common. We hypothesized that a respiratory therapist-driven mechanical ventilation bundle could increase adherence to lung-protective ventilation and decrease the incidence of pulmonary complications in the ICU.

Capnography for Monitoring of the Critically Ill Patient.

Capnography has been widely adopted in multiple clinical areas. The capnogram and end-tidal carbon dioxide offer a wealth of information, in the right clinical setting, and when properly interpreted. In this article, the authors aim to review the most common clinical scenarios during which capnography has been shown to be of benefit.

Epinephrine before defibrillation in patients with shockable in-hospital cardiac arrest: propensity matched analysis.

Objective: To determine the use of epinephrine (adrenaline) before defibrillation for treatment of in-hospital cardiac arrest due to a ventricular arrhythmia and examine its association with patient survival.

Design: Propensity matched analysis.

Setting: 2000-18 data from 497 hospitals participating in the American Heart Association’s Get With The Guidelines-Resuscitation registry.

Central venous-to-arterial PCO difference as a marker to identify fluid responsiveness in septic shock.

Defining the hemodynamic response to volume therapy is integral to managing critically ill patients with acute circulatory failure, especially in the absence of cardiac index (CI) measurement. This study aimed at investigating whether changes in central venous-to-arterial CO difference (Δ-ΔPCO) and central venous oxygen saturation (ΔScvO) induced by volume expansion (VE) are reliable parameters to define fluid responsiveness in sedated and mechanically ventilated septic patients. We prospectively studied 49 critically ill septic patients in whom VE was indicated because of circulatory failure and clinical indices.

A Prospective Analysis of Motor and Cognitive Skill Retention in Novice Learners of Point of Care Ultrasound.

Objectives: To identify the time at which point of care ultrasound static image recognition and image acquisition skills decay in novice learners.

Setting: The University of Iowa Hospitals and Clinics.

Subjects: Twenty-four subjects (23 first-year medical students and one first-year physician assistant student).

Usefulness of venous-to-arterial partial pressure of CO difference to assess oxygen supply to demand adequacy: effects of dobutamine.

The central venous O saturation value and lactic acid levels are part of the diagnostic and therapeutic work up of patients in shock. These usual indicators of tissue hypoxia don't fully describe the adequacy of tissue perfusion. There is ample evidence that supplementing this data with the venous-to-arterial partial pressure of CO (PCO) difference (ΔPCO) complements the clinician's tools when treating patients with shock.

Estimating Arterial Partial Pressure of Carbon Dioxide in Ventilated Patients: How Valid Are Surrogate Measures?

The arterial partial pressure of carbon dioxide (Pa) is an important parameter in critically ill, mechanically ventilated patients. To limit invasive procedures or for more continuous monitoring of Pa, clinicians often rely on venous blood gases, capnography, or transcutaneous monitoring. Each of these has advantages and limitations.

Improving CPR Performance.

Cardiac arrest continues to represent a public health burden with most patients having dismal outcomes. CPR is a complex set of interventions requiring leadership, coordination, and best practices. Despite the widespread adoption of new evidence in various guidelines, the provision of CPR remains variable with poor adherence to published recommendations.

Using electronic medical record notes to measure ICU telemedicine utilization.

Given the complexity of high-acuity health care, designing an effective clinical note template can be beneficial to both document patient care and clarify how telemedicine is used. We characterized documented interactions via a standardized note template between bedside intensive care unit (ICU) providers and teleintensivists in 2 Veterans Health Administration ICU telemedicine support centers. All ICUs linked to support centers and providing care from October 2012 through September 2014 were considered.

Capnography During Critical Illness.

Capnography has made steady inroads in the ICU and is increasingly used for all patients who are mechanically ventilated. There is growing recognition that capnography is rich in information about lung and circulatory physiology and provides insight into many diseases and treatments. These include conditions of impaired matching of ventilation and perfusion, such as pulmonary embolism and obstructive lung diseases; circulatory questions, such as the adequacy of chest compressions during cardiac arrest or fluid responsiveness in patients in shock; and the safety of procedural sedation.

Impact of an intensive care unit telemedicine program on patient outcomes in an integrated health care system.

Importance: Intensive care unit (ICU) telemedicine (TM) programs have been promoted as improving access to intensive care specialists and ultimately improving patient outcomes, but data on effectiveness are limited and conflicting.

Objective: To examine the impact of ICU TM on mortality rates and length of stay (LOS) in an integrated health care system.

Design, Setting, And Participants: Observational pre-post study of patients treated in 8 "intervention" ICUs (7 hospitals within the US Department of Veterans Affairs health care system) during 2011-2012 that implemented TM monitoring during the post-TM period as well as patients treated in concurrent control ICUs that did not implement an ICU TM program.

Abundant DNase I-sensitive bacterial DNA in healthy porcine lungs and its implications for the lung microbiome.

Human lungs are constantly exposed to bacteria in the environment, yet the prevailing dogma is that healthy lungs are sterile. DNA sequencing-based studies of pulmonary bacterial diversity challenge this notion. However, DNA-based microbial analysis currently fails to distinguish between DNA from live bacteria and that from bacteria that have been killed by lung immune mechanisms, potentially causing overestimation of bacterial abundance and diversity.

Trendelenburg position does not increase cross-sectional area of the internal jugular vein predictably.

Background: The Trendelenburg position is used to distend the central veins, improving both the success and safety of vascular cannulation. The purpose of this study was to measure the cross-sectional area (CSA) of the internal jugular vein (IJV) in three different positions using surface ultrasonography.

Methods: Fifty-one subjects were enrolled.

The flow-time waveform predicts respiratory system resistance and compliance.

Purpose: Knowledge of patients' lung compliance and resistance aids clinical management. We investigated whether these values, readily measured during volume assist-control ventilation (VACV), could also be estimated during pressure assist-control ventilation (PACV).

Methods: Data were collected in 12 mechanically ventilated human subjects.

The ΔF508 mutation causes CFTR misprocessing and cystic fibrosis-like disease in pigs.

Cystic fibrosis (CF) is an autosomal recessive disease caused by mutations in the gene encoding the cystic fibrosis transmembrane conductance regulator (CFTR) anion channel. The most common CF-associated mutation is ΔF508, which deletes a phenylalanine in position 508. In vitro studies indicate that the resultant protein, CFTR-ΔF508, is misprocessed, although the in vivo consequences of this mutation remain uncertain.